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Forgiveness and Health in PLWHA: A Systematic Review of the Literature

This presentation focuses on the findings of a systematic review of forgiveness studies in People Living with HIV/AIDS (PLWHA). It provides an overview of forgiveness, the method of the review study, the studies on forgiveness in PLWHA, and the findings of those studies. The implications and conclusions of forgiveness for health in PLWHA are also discussed.

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Forgiveness and Health in PLWHA: A Systematic Review of the Literature

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  1. Forgiveness and Health in PLWHA Judith A. Osae-Larbi Department of Psychology University of Ghana 10th May 2018 A Systematic Review of the Literature

  2. This presentation focuses on findings of a systematic review of Forgiveness studies in PLWHA: What has been done and found so far? 1. Brief overview of Forgiveness 2. Method of the systematic review study 3. Overview of studies on Forgiveness in PLWHA 4. Findings of studies on Forgiveness in PLWHA 5. Discussion, implications and Conclusion

  3. Forgiveness is an emotion-focused strategy for coping with injustices. It is a complex multidimensional and multicontextual phenomenon. Decisional Forgiveness: Deciding to forgo negative thoughts, affect, and behaviour toward the offender. (Worthington & Scherer, 2004). Trait State What Forgiveness is NOT Freely made choice to forgo negative cognitive, emotional, and behavioural responses toward a person who caused a hurt, and work toward developing positive cognitive, emotional, and behavioural responses. Enright and Fitzgibbons (2000) • Forbearance • Condoning • Forgetting • Justifying • Excusing • Reconciling • Getting Justice • Taking revenge Emotional forgiveness: replacement of negative unforgiving emotions with positive emotions (e.g. empathy, humility, love) toward the transgressor. (Worthington & Scherer, 2004). Interpersonal Intrapersonal Spiritual

  4. A search of 8 databases using search terms: Forgiv* & HIV/AIDS, 3 handbooks, and reference sections of related publications. • PsychINFO • MEDLINE • PsycARTICLES • CINAHL Plus • PubMed • J. of the Int. AIDS Society • AIDS and Behaviour J. • Conference Abstracts Archive IAS • Handbook of Forgiveness • Forgiveness &Health Handbook • Handbook of Self-Forgiveness • ALWHA self-reported Forgiveness. • Forgiveness assessed in relation to ≥1 health outcomes. Search Strategy and Papers Retrieved Databases & Handbooks Inclusion Criteria

  5. Overview of studies identified on Forgiveness in PLWHA

  6. Overview of studies identified on Forgiveness in PLWHA

  7. Findings: Forgiveness and Quality of Life Studies • Women: >Forgiveness on Fg & blame facet of WHOQOLHIV-120; Younger & married women: >Forgiveness.1 • High Dis Forgiveness, Less MCoping, High QOL: MC mediated DF & QOL.2 • Self-Fg & Other-Fg corr. with all QOL domains. Only self-Fg predicted pain (p<.001) & role fxn (p<.01). >attachment anxiety: >Other-Fg asso >QOL-Pain, >Self-Fg >perceived improved health.5 • >Fg corr. with >QOL (r=.322, p<.001); more strongly than R.involvement & QOL (r = .264, p=.002).8

  8. Forgiveness, Depression & Physiological Markers Studies • Fg corr. with <depressive symptoms (r=-.44, p<.001); more strongly than R. involvement (r = -.24, p<.005).8 • >Forgiveness: <depression (p<.012) & <stigma (p<.05). However Fg did not moderate between stigma and deression.11 • >Forgiveness: >CD4 cell%, controlling for gender, sub. use, ARTadh, VL.10 • >PVOG: >CD4 (p=.03) & <VL (p=.03); >NVOG: <CD4 (p<.001) & >VL (p=.002) controlling for BL CD4, VL, age, gender, ethnicity, edu, ART. Remained sig. predictors adjusting for relig, ARTadhe, SRB, SU, depression, coping, & SS.3

  9. Forgiveness and other Psychosocial Outcomes • >Belief in God’s Fg corr > prior resuscitation discussions (p=.043). >belief in HIV as punishment from God corr <discussions.4 • >Dis Forgiveness: >contraception use to prevent pregnancy.7 • >Perceived family stigma strongest predictor of stage1 state Fg (p<.001); PFS completely mediated P. societal stigma & stage1 state Fg (p<>05).6 • > Self-Fg was better predictor of HIV-related stigma than Other-Fg. Overall, Fg intervention not effective in reducing overall HIV-related stigma.12 • >Fg corr. <severity of life stressors (r=-.32) & >health satisfaction (r=.34, p<.001) more than R. involvement (r= -.31 & r=.32, p<.001). corr <unpro sex (r=-.19, p=.03)8. Feeling unFgn: >missed doses of ART in previous week.9

  10. Discussion and General Implications of Findings General Implications Discussion • Longitudinal RCTs across cultures & for diff stages & contexts of Forgiveness. • Cross-cultural validation of vignette measure by Wald & Temoshok.8,9. Careful consideration of Fg/ unFg may help curb 20 transmission of HIV. Careful assessment & EvB interv. for hurts & unFg may promote +ve health behaviours. Future Studies Critical role in clinical & PROs + supports stress & coping model Fg • Support for both direct & indirect theorized pathways? • Studies in all 3 contexts but global Dis Fg: impact of diff. Fg stages? • Method: Sample size, CS designs, culture-collectivistic societies & forbearance, Qual studies? Public Health Clinical Practice

  11. Implications for Research in Ghana & Conclusion Conclusion Fg. Research in Ghana Overall, cross-sectional evidence suggest an association between Forgiveness and positive health outcomes in PLWHA. Rigorous studies needed to establish whether Forgiveness indeed is a cause of positive health outcomes in this population of PH significance. Quantitative Studies • Does the Fg-health link “exist” in PLWHA in Gh? CS exploration  Long. • Predictors of Fg in PLWHA in Gh. • Intervention studies  RCTs. • Range of HIV-specific offense situations? • Lived exp. of Fg of HIV-specific offenses? • Conceptualizations of Fg, forbearance & reconciliation? Qualitative Studies

  12. References • Chandra, P. S., Satyanarayana, V. A., Satishchandra, P., Satish, K. S., & Kumar, M. (2009). Do men and women with HIV differ in their quality of life? A study from South India. AIDS and Behavior, 13(1), 110-117. • Gates, M. S. (2012). Devaluing Stigma in the Context of Forgiveness, Coping and Adaptation: A Structural Regression Model of Reappraisal (Doctoral dissertation, University of North Texas). • Ironson, G., Stuetzle, R., Ironson, D., Balbin, E., Kremer, H., George, A., ... & Fletcher, M. A. (2011). View of God as benevolent and forgiving or punishing and judgmental predicts HIV disease progression. Journal of behavioral medicine, 34(6), 414-425. •  Kaldjian, L. C., Jekel, J. F., & Friedland, G. (1998). End‐of‐life decisions in HIV‐positive patients: The role of spiritual beliefs. Aids, 12(1), 103-107. • Martin, L. A., Vosvick, M., & Riggs, S. A. (2012). Attachment, forgiveness, and physical health quality of life in HIV+ adults. AIDS care, 24(11), 1333-1340. • Muhomba, M. (2008). The relationship between HIV/AIDS-related stigma and the process of forgiveness with a special focus on the family context. ProQuest. Doctoral dissertation. • De La Cruz, N. (2009). Parenting practices and desire for a child among mothers living with HIV. The University of Alabama at Birmingham. • Wald, R. L., & Temoshok, L. R. (2004a). Spirituality, forgiveness, and health in a US inner-city HIV clinic. In Proceedings, XV International AIDS Conference, Bangkok, Thailand (pp. 55-58). • Wald, R. L., & Temoshok, L. R. (2004b). Subjective beliefs about health care predict adherence to anti-retroviral medications in a US clinic. In International Proceedings of the XV International AIDS Conference, Bologna, Italy. Medimond (pp. 257-60). • Owen, A. D., Hayward, R. D., & Toussaint, L. L. (2011). Forgiveness and immune functioning in people living with HIV-AIDS. Paper presented at the 32nd annual meeting of the Society for Behavioral Medicine, Washington, DC. • Ridings, J., & Vosvick, M. (2008). Stigma, forgiveness and depression in HIV+ women. Annals of Behavioral Medicine,35(supple), C187. •   Hua, W. Q. (2012). Back in my hands: The role of self-forgiveness and stigma in HIV-positive adults. University of North Texas.

  13. Thank You. Questions?

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